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Individual

MR. JOHNNY PAUL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DPH

Contact information

Practice address
516-B WEST MAIN STREET, SMITHVILLE, TN 37166-0299
(615) 597-7822
(615) 597-1112
Mailing address
P. O. BOX 126, SMITHVILLE, TN 37166-1118
(615) 597-7822
(615) 597-1112

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
C006677
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
150553
BC/BS
TN
01
3563964
TN MEDICAL ASSISTANCE PRO
TN
01
4427313
NCPDP
TN
05
9449808
TN
Enumeration date
10/17/2005
Last updated
07/08/2007
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